F&N Bulletin Vol 23 No 1b - United Nations University

More documents

Recommendations

Info

Letter to the editor Dear Sir, Community-based salt iodization program administered by hand sprayers: A trial in Mongolia since 1999 Salt iodization is the most commonly accepted strategy for the control of iodine-deficiency disorders in more than 100 countries that have launched salt iodization programs [1]. WHO/UNICEF/International Council for Control of Iodine-Deficiency Disorders (ICCIDD) recommends a national usage rate of iodized salt of at least 90% for the effective prevention of iodinedeficiency disorders [2]. Mongolia began its salt iodization program in 1996 with nine salt companies, and by 1998, its national coverage had only reached the 42% level [3], in spite of nearly 100% coverage in the capital, Ulaanbaatar. We figured that the high price of iodized salt in comparison with natural salt and its poor distribution in rural areas were the main obstacles to popularizing the use of iodized salt. The price of the iodized salt was twice that of natural salt in Ulaanbaatar and three to seven times in outlying areas. Out of 3,660 tons of iodized salt produced in 1998, we found that less than 40% was consumed in rural areas, which have 75% of the population. We also inferred that the program would not make much progress under current economic and political constraints. Therefore, it was time to develop and introduce a new program, supplementary to the current salt iodization program, which focused on community ownership. We developed the safe-spray method, which iodized 1 kg of salt to 30 ppm with three sprays of a measured solution of potassium iodate (KIO 3 ) by using durable hand sprayers. The procedure was to measure 1 kg of salt into a plastic bag, put the sprayer nozzle into the plastic bag with the tightly closed mouth of the bag around the nozzle, spray once and shake well, and then repeat the same procedure two more times. In 10 random samplings of 1 kg of the sprayed salt, the iodine content was constant, ranging only from 29.6 to 32.8 ppm (n=300). Uyanga, Taragt, and Zuiil, three villages with a high prevalence of goiter (31.1% to 41.3%) in Uvurkhangai Province 430 km southwest of the capital, agreed to participate in the program. The spray-method community initiative program (SMEP) in the three villages was approved by the Ministry of Health, which agreed to provide potassium iodate until 2002. The village committees then registered with the provincial government as iodized salt production sites. The SMEP officially started in August of 1999. Quality control of iodization was done by a field test kit (MBI company, India) to check the iodine content in 10 random samples per day. We established a laboratory for a titrimetric method in the Provincial Health Center, which examined 30 samples per month from each village. The local iodized salt was sold in the village hospitals for Tg. 120 (US$1.00 = Tg. 1,087, 1999) per kilogram of salt, and the prices of natural salt and iodized salt from Ulaanbaatar in retail shops were Tg. 100 to 130 and Tg. 350 to 400, respectively. When the hospital staff visited remote areas, they brought the sprayers and iodized natural salt to each household; the charge was Tg. 20 per kg. A baseline survey to assess iodine-deficiency disorder status and the use of salt was carried out in 1999. One hundred fifty-eight children aged 8 to 12 years and 64 women aged 15 to 45 years were selected randomly and examined. The median values of urinary iodine excretion indicated that they were at moderate risk for iodine-deficiency disorders. Iodized salt coverage in three villages increased from 10% in 1999 to 30% in 2000. Although iodine intake among the 300 children and 300 women was not yet adequate, those in village centers showed greater usage rates and urinary iodine excretion values than those in remote units. We found the reasons that residents in remote units did not use 108 Food and Nutrition Bulletin, vol. 23, no. 1 © 2002, The United Nations University.
Letter to the Editor 109 iodized salt were that many of them did not know about iodine-deficiency disorders or iodized salt or that they preferred to exchange their livestock for natural salt that was provided by salt sellers. Quality control systems in the villages and the provinces met standards after guidance that was provided in March 2000. The village committees secured their initial funding to purchase natural salt from a low-interest fund of foreign organizations to be repaid after one year. The village committees were eager to utilize the benefits from the salt for their health education activities and to distribute the salt to remote areas in their villages. However, because the low return from selling the salt, they could barely repay the loans after insufficient implementation of health education and distribution programs and had to ask for additional loans. To establish a sustainable program, initial funding, without repayment, for purchasing natural salt will be critical for success. For example, the estimated annual sum needed for the purchase of natural salt in the three villages is US$5,900. If this amount can be secured, the villages could continue and expand the activities, even when the benefit is small. Community sharing of this fund has been discussed. A next step in securing the initial funding would be to intensively publish health education information about iodinedeficiency disorders and promote iodized salt usage in order to achieve universal salt iodization. We will continue monitoring and supervising the intervention for a few more years. We have formulated a plan to expand this program to other disadvantaged areas in Mongolia after the intervention has been fully accepted by the communities, and we consider that this program will serve as a model for other countries in need. Chieri Yamada, Ph.D. School of Health Sciences Hirosaki University, Japan cyamada@cc.hirosaki-u.ac.jp D. Oyunchimeg, Ph.D. P. Enkhtuya, M. D. Ministry of Health, Mongolia Acknowledgments Funding for this project came from the Japan International Cooperation Agency, Japan. We appreciate the support of Mrs. Y. Akiyama. References 1. UNICEF Nutrition Section. Progress towards universal salt iodization. New York: UNICEF, 1994. 2. WHO/UNICEF/ICCIDD. Indicators for assessing iodine deficiency disorders and their control through salt iodization. Geneva: World Health Organization (WHO/NUT/94.9), 1994. 3. Yamada C, Oyunchimeg D, Enkhtuya P, Erdenbat A, Buttumur D, Umenai T. Current status of iodine deficiency disorders in Mongolia in 1998–1999. Asia Pacific J Public Health 2001;12(2).
Page 1 and 2:
Contents Review articles Nuclear an
Page 3 and 4:
Special Article Nuclear and isotopi
Page 5 and 6:
Nuclear and isotopic techniques 5 T
Page 7 and 8:
Nuclear and isotopic techniques 7 T
Page 9 and 10:
Nuclear and isotopic techniques the
Page 11 and 12:
Palm oil: A healthful and cost-effe
Page 13 and 14:
Palm oil will be less absorbed and
Page 15 and 16:
Palm oil oil at the present time is
Page 17 and 18:
Palm oil crystal forms for the requ
Page 19 and 20:
Palm oil myristic acid (14:0) is hi
Page 21 and 22:
Palm oil 13. Kritchevsky D. Influen
Page 23 and 24:
Introduction to three regional stud
Page 25 and 26:
Nutritional status of urban primary
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Regional study of nutritional statu
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Regional study of nutritional statu
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Street food vendors their consumers
Page 51 and 52:
Street food vendors whereas roasted
Page 53 and 54:
Street food vendors Reardon [28] co
Page 55 and 56:
Street food vendors so that bad pre
Page 57 and 58: Iron and energy supplementation imp
Page 59 and 60: Iron and energy supplementation the
Page 61 and 62: Iron and energy supplementation The
Page 63 and 64: Iron and energy supplementation 63
Page 65 and 66: Toward better compliance with iron-
Page 73 and 74: Development and validation of a sho
Page 83 and 84: Factors associated with successful
Page 89 and 90: Difference in goiter rates between
Page 91 and 92: Difference in goiter rates Methods
Page 93 and 94: Difference in goiter rates iodized
Page 95 and 96: Iron-deficiency anemia in young wor
Page 107: Discussion paper What care practice
Page 111 and 112: News and notes 2001 World Food Priz
Page 113 and 114: UNU Food and Nutrition Programme NU
Page 115: Note for contributors The editors o
show all

F&N Bulletin Vol 23 No 1b - United Nations University

Create successful ePaper yourself

Delete template?

Save as template?